Wade in the Water Medicine LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD24920 Issued in TN

Legal business name

WADE IN THE WATER MEDICINE LLC

Practice address

5600 Brainerd Rd
FC5
Chattanooga, TN 37411-5310

Phone

(423) 355-5471

Fax

(423) 355-5472

NPI assigned

Jun 11, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Carroll G Odem, MD

Title

President

Phone

(423) 400-9910

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398816000000",
    "number": "1629416730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 BRAINERD RD",
            "address_2": "FC5",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374115310",
            "telephone_number": "423-355-5471",
            "fax_number": "423-355-5472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 BRAINERD RD",
            "address_2": "FC5",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374115310",
            "telephone_number": "423-355-5471",
            "fax_number": "423-355-5472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADE IN THE WATER MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-11",
        "last_updated": "2014-04-30",
        "status": "A",
        "authorized_official_last_name": "ODEM",
        "authorized_official_first_name": "CARROLL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-400-9910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TN",
            "license": "MD24920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Ann Vukmer
• W.E.S Transports LLC
• Heather Ellison Waddell, PHARM D
• Jeremy B. Waddell, P.A.-C.
• Casey M. Waddle, NP
• Cynthia Wade
• Holly Elizabeth Wade, LCSW
• Jason Daniel Wade, RN
• Katie Danielle Wade, MSN, APRN, PMHNP-BC
• Robin E. Wade

• Specialist in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.